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Golukhova EZ, Lifanova LS, Pugovkina YV, Grigoryan MV, Bulaeva NI. Should We Monitor Glucose and Biomarkers in Diabetics over Heart Surgery? J Clin Med 2021; 10:jcm10153399. [PMID: 34362176 PMCID: PMC8348301 DOI: 10.3390/jcm10153399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 07/22/2021] [Accepted: 07/28/2021] [Indexed: 11/16/2022] Open
Abstract
Hyperglycemia is associated with adverse outcomes after coronary artery bypass grafting (CABG). While there is a consensus that blood glucose control may benefit patients undergoing CABG, the role of biomarkers, optimal method, and duration of such monitoring are still unclear. The aim of this study is to define the efficacy of a continuous glucose monitoring system (CGMS) and link it to pro-inflammatory biomarkers while on insulin pump therapy in diabetic patients undergoing CABG. We prospectively assessed CGMS for 72 h in 105 patients including 52 diabetics undergoing isolated CABG. In diabetics, CGMS was connected to an insulin pump for precise glucose control. On top of conventional biomarkers (HbA1C, lipid profile), high sensitive C-reactive protein (hs-CRP), Regulated upon Activation Normal T cell Expressed and presumably Secreted (RANTES), and leptin levels were collected before surgery, 1 h, 12 h, 7 days, and at 1 year after CABG. Overall, CGMS revealed high glucose independently from underlying diabetes during first 48 h following CABG but was higher (p < 0.05) in diabetics. The insulin pump improved glycemic control over early follow-up (72 h) post-CABG. There were no hypoglycemic episodes in patients on insulin pump therapy and those receiving bolus insulin therapy. We revealed a lower rate of postpericardiotomy syndrome (PCTS) in patients on insulin pump therapy compared to patients prescribed bolus insulin therapy in the early postoperative period (p = 0.03). Hs-CRP and RANTES levels were lower in patients with T2DM on insulin pump therapy compared to patients prescribed bolus insulin therapy in the early postoperative period (p < 0.05). It is most likely due to the fact that insulin pump therapy decreases systemic inflammatory response. Further controlled trials should assess whether CGMS improves outcomes after cardiac surgery.
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Meng L, Li J, He Y, Xiong Y, Li J, Wang J, Shi Y, Liu Y. The risk factors analysis and establishment of an early warning model for healthcare-associated infections after pediatric cardiac surgery: A STROBE-compliant observational study. Medicine (Baltimore) 2020; 99:e23324. [PMID: 33285709 PMCID: PMC7717841 DOI: 10.1097/md.0000000000023324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 08/10/2020] [Accepted: 10/21/2020] [Indexed: 11/25/2022] Open
Abstract
The aim of this study was to identify the main risk factors for health-care-associated infections (HAIs) following cardiac surgery and to establish an effective early warning model for HAIs to enable intervention in an earlier stage.In total, 2227 patients, including 222 patients with postoperative diagnosis of HAIs and 2005 patients with no-HAIs, were continuously enrolled in Beijing Anzhen Hospital, Beijing, China. Propensity score matching was used and 222 matched pairs were created. The risk factors were analyzed with the methods of univariate and multivariate logistic regression. The receiver operating characteristic (ROC) curve was used to test the accuracy of the HAIs early warning model.After propensity score matching, operation time, clamping time, intubation time, urinary catheter time, central venous catheter time, ≥3 blood transfusions, re-endotracheal intubation, length of hospital stay, and length of intensive care unit stay, still showed significant differences between the 2 groups. After logistic model analysis, the independent risk factors for HAIs were medium to high complexity, intubation time, urinary catheter time, and central venous catheter time. The ROC showed the area under curve was 0.985 (confidence interval: 0.975-0.996). When the probability was 0.529, the model had the highest prediction rate, the corresponding sensitivity was 0.946, and the specificity was 0.968.According to the results, the early warning model containing medium to high complexity, intubation time, urinary catheter time, and central venous catheter time enables more accurate predictions and can be used to guide early intervention after pediatric cardiac surgery.
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Affiliation(s)
- Lihui Meng
- Pediatric Cardiac Center, Department of Cardiac Surgery
- Health-care Associated Infection Management Office, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jiachen Li
- Pediatric Cardiac Center, Department of Cardiac Surgery
| | - Yan He
- Pediatric Cardiac Center, Department of Cardiac Surgery
| | - Ying Xiong
- Health-care Associated Infection Management Office, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jingming Li
- Health-care Associated Infection Management Office, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jing Wang
- Health-care Associated Infection Management Office, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ying Shi
- Health-care Associated Infection Management Office, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yinglong Liu
- Pediatric Cardiac Center, Department of Cardiac Surgery
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Berger I, Xia L, Wirtalla C, Dowzicky P, Guzzo TJ, Kelz RR. 30-day readmission after radical cystectomy: Identifying targets for improvement using the phases of surgical care. Can Urol Assoc J 2018; 13:E190-E201. [PMID: 30472980 DOI: 10.5489/cuaj.5455] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Postoperative readmissions following radical cystectomy (RC) have gained attention in the past decade. Postoperative and post-discharge complications play a role in readmission rates; however, our ability to predict readmissions remains poor. METHODS Using the National Surgical Quality Improvement Program database, we identified patients with bladder cancer undergoing RC from 2013-2015. Complications were defined as postoperative and post-discharge. Outcomes were 30-day readmission, post-discharge complications, and post-discharge major complications. Patient, operative, and complication factors were assessed using multivariable logistic regression. RESULTS We identified 4457 patients who underwent RC; 9.2% of patients experienced a postoperative complication, 18.8% experienced a post-discharge complication, and 20.3% were readmitted. Overweight and obese body mass index (BMI), dependent functional status, chronic obstructive pulmonary disease (COPD), a continent diversion, and duration of operation were associated with post-discharge complications. Postoperative complications were not associated with post-discharge complications. Readmission was associated with Black race (odds ratio [OR] 1.5; 95% confidence interval [CI] 1.0-2.1), overweight (OR 1.5; 95% CI 1.2-1.8) and obese BMI (OR 1.5; 95% CI 1.2-1.9), diabetes (OR 1.2; 95% CI 1.0-1.5), COPD (OR 1.4; 95% CI 1.0-1.8), steroid use (OR 1.5; 95% CI 1.0-2.2), a continent diversion (OR 1.4; 95% CI 1.1-1.7), duration of operation (OR 1.1; 95% CI 1.1-1.2), and postoperative complications (OR 1.5; 95% CI 1.2-2.0). The majority of readmissions experienced a post-discharge complication. CONCLUSIONS Factors that span the preoperative, intraoperative, postoperative, and post-discharge phases of care were identified to increase readmission risk. To improve readmission rates, interventions will have to target factors across the surgical experience.
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Affiliation(s)
- Ian Berger
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States.,Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Leilei Xia
- Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Christopher Wirtalla
- Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Phillip Dowzicky
- Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States.,Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Thomas J Guzzo
- Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Rachel R Kelz
- Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States.,Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
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Yuan X, Li B, Sun H, Yang Y, Meng H, Xu L, Song Y, Xu J. Surgical Outcome in Adolescents and Adults With Anomalous Left Coronary Artery From Pulmonary Artery. Ann Thorac Surg 2018; 106:1860-1867. [PMID: 29928853 DOI: 10.1016/j.athoracsur.2018.05.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 05/06/2018] [Accepted: 05/16/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The outcomes of different repair strategies of an anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) in adolescent and adult patients are uncertain. The long-term outcomes of reimplantation and Takeuchi repair were compared in this study. METHODS We conducted a retrospective review of data collected from patients receiving ALCAPA repair at our institute from January 2005 to December 2016. Short- and long-term outcomes of reimplantation and Takeuchi repair were compared. RESULTS A total of 50 consecutive patients underwent ALCAPA repair, with an average age of 31.6 ± 15.6 years and 66% women. No significant differences were found in short-term outcomes between the 2 groups. However, at a median of 65.7 months' follow-up, the major adverse cardiovascular event (MACE) (including all-cause death, admission due to heart failure, new-onset acute myocardial infarction, and repeated revascularization) rate of the Takeuchi repair group was significantly lower than that of the reimplantation group (hazard ratio, 0.21; 95% confidence interval, 0.04 to 0.97). Furthermore, the preoperative glucose level was significantly associated with increased MACE rate (hazard ratio, 10.82; 95% confidence interval, 1.20 to 97.54). Left ventricular end-diastolic diameter and ejection fraction significantly improved in both groups. However, mitral valvuloplasty did not predict long-term recovery of left ventricular function. CONCLUSIONS Although short-term outcomes were satisfactory in both groups, a higher MACE rate was observed in reimplantation group than Takeuchi repair group; mitral valvuloplasty was not significantly associated with improved prognosis and left ventricular reverse remodeling. Elevation of preoperative blood glucose level was significantly associated with increasing long-term MACE rate.
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Affiliation(s)
- Xin Yuan
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Adult Cardiac Surgery Department, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bin Li
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Adult Cardiac Surgery Department, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hansong Sun
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Adult Cardiac Surgery Department, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Yan Yang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Adult Cardiac Surgery Department, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hong Meng
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Sonography Department, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Liang Xu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Radiology Department, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yunhu Song
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Adult Cardiac Surgery Department, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianping Xu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Adult Cardiac Surgery Department, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Vrancic JM, Piccinini F, Camporrotondo M, Espinoza JC, Camou JI, Nacinovich F, Oses PF, Navia D. Bilateral Internal Thoracic Artery Grafting Increases Mediastinitis: Myth or Fact? Ann Thorac Surg 2016; 103:834-839. [PMID: 27659597 DOI: 10.1016/j.athoracsur.2016.06.080] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 06/15/2016] [Accepted: 06/22/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND There is controversy about the risk of mediastinitis associated with the use of both internal thoracic arteries (ITA). METHODS We performed a case-control study of patients operated on at a single institution from January 2003 to December 2014. A total of 3,118 consecutive patients undergoing isolated coronary artery bypass graft surgery were included; 81.3% (n = 2,533) underwent bilateral ITA (BITA) grafts exclusively and constitute the BITA group, and 18.7% (n = 585) constitute the single ITA (SITA) group. Mediastinitis was defined as deep tissue mediastinal infection, with clinical or microbiologic evidence. Continuous variables were expressed as mean ± SD, and categoric variables as percentage (range). Student's t test and Fisher's exact test were used, as appropriate. Propensity score matching analysis was performed according to the nearest neighbor estimation method (n = 1,040). RESULTS The incidence of diabetes mellitus was similar in both groups (29%, p = 0.9). The BITA patients were more like to be younger (p < 0.001), men (p < 0.001), had a higher prevalence of hypertension (p < 0.01), higher body mass index (p < 0.001), lower prevalence of left ventricular dysfunction (p < 0.001) and of previous myocardial infarction (p < 0.01), and greater use of off-pump coronary artery bypass graft surgery (p < 0.01). The BITA patients had lower unadjusted hospital mortality (1.6%, versus 5.3% for SITA, p < 0.0001). The total incidence of mediastinitis was 1.8% (BITA 1.9% versus SITA 1.5%, p = 0.6). Diabetes (p < 0.01) and nonelective surgery (p = 0.004) were the only predictors of mediastinitis in the entire population. Propensity score matching showed no differences in mediastinitis: BITA 2.5% versus SITA 1.3% (p = 0.17). CONCLUSIONS In this series of patients, BITA did not increase the risk of mediastinitis in the total population or in the propensity score matched subgroups.
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Affiliation(s)
- Juan M Vrancic
- Department of Cardiac Surgery, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina.
| | - Fernando Piccinini
- Department of Cardiac Surgery, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Mariano Camporrotondo
- Department of Cardiac Surgery, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Juan C Espinoza
- Department of Cardiac Surgery, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Juan I Camou
- Department of Cardiac Surgery, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Francisco Nacinovich
- Department of Infectious diseases, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Pablo Fernandez Oses
- Department of Infectious diseases, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Daniel Navia
- Department of Cardiac Surgery, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
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Harp JB, Yancopoulos GD, Gromada J. Glucagon orchestrates stress-induced hyperglycaemia. Diabetes Obes Metab 2016; 18:648-53. [PMID: 27027662 PMCID: PMC5084782 DOI: 10.1111/dom.12668] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 03/19/2016] [Accepted: 03/24/2016] [Indexed: 01/08/2023]
Abstract
Hyperglycaemia is commonly observed on admission and during hospitalization for medical illness, traumatic injury, burn and surgical intervention. This transient hyperglycaemia is referred to as stress-induced hyperglycaemia (SIH) and frequently occurs in individuals without a history of diabetes. SIH has many of the same underlying hormonal disturbances as diabetes mellitus, specifically absolute or relative insulin deficiency and glucagon excess. SIH has the added features of elevated blood levels of catecholamines and cortisol, which are not typically present in people with diabetes who are not acutely ill. The seriousness of SIH is highlighted by its greater morbidity and mortality rates compared with those of hospitalized patients with normal glucose levels, and this increased risk is particularly high in those without pre-existing diabetes. Insulin is the treatment standard for SIH, but new therapies that reduce glucose variability and hypoglycaemia are desired. In the present review, we focus on the key role of glucagon in SIH and discuss the potential use of glucagon receptor blockers and glucagon-like peptide-1 receptor agonists in SIH to achieve target glucose control.
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Affiliation(s)
- J B Harp
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | | | - J Gromada
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
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Musallam E. The predictors of surgical site infection post cardiac surgery: A systematic review. JOURNAL OF VASCULAR NURSING 2014; 32:105-18. [DOI: 10.1016/j.jvn.2014.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 01/04/2014] [Accepted: 01/06/2014] [Indexed: 11/29/2022]
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Bajwa SJS, Sehgal V, Kalra S, Baruah MP. Management of diabetes mellitus type-2 in the geriatric population: Current perspectives. J Pharm Bioallied Sci 2014; 6:151-7. [PMID: 25035634 PMCID: PMC4097928 DOI: 10.4103/0975-7406.130956] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 06/06/2013] [Accepted: 09/29/2013] [Indexed: 01/04/2023] Open
Abstract
The prevalence of diabetes mellitus (DM) has increased exponentially throughout the world and there is rapid increase in elderly diabetics. DM is associated with increased mortality and considerable morbidity including stroke, heart disease, and diminished quality of life in the elderly. However, the unique features of geriatric diabetes have not been given due a prominence in medical literature. Hypoglycemia remains the biggest complicating factor and needs to be avoided in the elderly. Most people in the geriatric age group have some degree of renal insufficiency and medications need to be adjusted wisely with changing renal profile. Because safer and more effective pharmacological therapy is available, an individual approach to DM in the elderly is essential.
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Affiliation(s)
- Sukhminder Jit Singh Bajwa
- Department of Anaesthesiology and Intensive Care Medicine, Gian Sagar Medical College and Hospital, Patiala, Punjab, India
| | - Vishal Sehgal
- Department of Internal Medicine, The Common Wealth Medical College, Scranton, PA 18510, USA
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital and B.R.I.D.E., Karnal, Haryana, India
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Arum O, Saleh JK, Boparai RK, Kopchick JJ, Khardori RK, Bartke A. Preservation of blood glucose homeostasis in slow-senescing somatotrophism-deficient mice subjected to intermittent fasting begun at middle or old age. AGE (DORDRECHT, NETHERLANDS) 2014; 36:9651. [PMID: 24789008 PMCID: PMC4082609 DOI: 10.1007/s11357-014-9651-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 03/26/2014] [Indexed: 05/19/2023]
Abstract
Poor blood glucose homeostatic regulation is common, consequential, and costly for older and elderly populations, resulting in pleiotrophically adverse clinical outcomes. Somatotrophic signaling deficiency and dietary restriction have each been shown to delay the rate of senescence, resulting in salubrious phenotypes such as increased survivorship. Using two growth hormone (GH) signaling-related, slow-aging mouse mutants we tested, via longitudinal analyses, whether genetic perturbations that increase survivorship also improve blood glucose homeostatic regulation in senescing mammals. Furthermore, we institute a dietary restriction paradigm that also decelerates aging, an intermittent fasting (IF) feeding schedule, as either a short-term or a sustained intervention beginning at either middle or old age, and assess its effects on blood glucose control. We find that either of the two genetic alterations in GH signaling ameliorates fasting hyperglycemia; additionally, both longevity-inducing somatotrophic mutations improve insulin sensitivity into old age. Strikingly, we observe major and broad improvements in blood glucose homeostatic control by IF: IF improves ad libitum-fed hyperglycemia, glucose tolerance, and insulin sensitivity, and reduces hepatic gluconeogenesis, in aging mutant and normal mice. These results on correction of aging-resultant blood glucose dysregulation have potentially important clinical and public health implications for our ever-graying global population, and are consistent with the Longevity Dividend concept.
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Affiliation(s)
- Oge Arum
- Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, IL, 62794, USA,
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[What should no longer be seen when performing a CPB]. ACTA ACUST UNITED AC 2014; 33 Suppl 1:S5-9. [PMID: 24613249 DOI: 10.1016/j.annfar.2014.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 01/29/2014] [Indexed: 11/21/2022]
Abstract
Cardiac surgery and cardiopulmonary bypass (CPB) have made significant progress in recent years. Despite these efforts, adverse events continue to occur during surgery. From recent studies of incidents and accidents during CPB, this article focuses on critical recommendations to respect when in charge of a CPB. Some facts are based only on data unsupported by scientific research. Others have not proven their benefit in terms of postoperative morbidity or mortality. The management of anticoagulation, hematocrit, pump flow, and the temperature is discussed. Finally, the importance of teamwork especially in terms of cohesion and communication is highlighted.
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Yavuz S, Eris C. eComment. Intraoperative glycaemic control in cardiac surgical patients. Interact Cardiovasc Thorac Surg 2013; 17:478. [PMID: 23956361 DOI: 10.1093/icvts/ivt284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Senol Yavuz
- Cardiovascular Surgery, Bursa Yuksek Ihtisas Education and Research Hospital, Bursa, Turkey
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12
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Bartlett R, Hartle AJ. Routine use of dexamethasone for postoperative nausea and vomiting: the case against. Anaesthesia 2013; 68:892-6. [DOI: 10.1111/anae.12309] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- R. Bartlett
- St Mary's Hospital; Imperial College Healthcare NHS Trust; London; UK
| | - A. J. Hartle
- St Mary's Hospital; Imperial College Healthcare NHS Trust; London; UK
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Valent F, Tillati S, Zanier L. Prevalence and comorbidities of known diabetes in northeastern Italy. J Diabetes Investig 2013; 4:355-60. [PMID: 24843679 PMCID: PMC4020229 DOI: 10.1111/jdi.12043] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 12/03/2012] [Accepted: 12/03/2012] [Indexed: 12/19/2022] Open
Abstract
AIMS/INTRODUCTION We aimed at estimating the prevalence and at identifying the frequent comorbidities of diabetes mellitus in a region of northeastern Italy from administrative health data. MATERIALS AND METHODS The prevalence was estimated according to two disease definitions, based on administrative health data. Association rule mining was used to detect comorbid diagnoses that coexisted with a diagnosis of diabetes among patients admitted to the regional hospitals. RESULTS The prevalence of known diabetes in 2010 was 6.0-8.1%, with great variations by age class (from approximately 2% <60 years to more than 20% in some elderly age groups). Of 155,494 patients admitted to the hospital in 2011, 9,358 had a diagnosis of diabetes. A total of 12 rules satisfied our criteria for support (>0.5%) and confidence (>5%), and identified nine frequent isolated comorbidities and three pairs of comorbid diagnoses. The rule with the highest support (2.4%) and confidence (39.5%) identified the combination of diabetes and essential hypertension. CONCLUSIONS Association rule mining was useful, because it showed the complexity of diabetic patients. Clinical management of those patients cannot neglect comorbidities.
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Affiliation(s)
- Francesca Valent
- Epidemiological ServiceRegional Health DirectorateFriuli Venezia Giulia RegionUdineItaly
| | - Silvia Tillati
- Epidemiological ServiceRegional Health DirectorateFriuli Venezia Giulia RegionUdineItaly
| | - Loris Zanier
- Epidemiological ServiceRegional Health DirectorateFriuli Venezia Giulia RegionUdineItaly
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